Whenever you place your mental or physical impairment at issue with the expectation of receivingdisability compensation, the disability insurer (or other responsible party i.e. worker’s compensation)has a right to have a physician of its own choice examine you. Although the procedural rulesgoverning IME’s vary among federal and state jurisdictions, several general requirements areuniversal. Some disability policies have contractual provisions requiring you to submit to an IME, ifrequested, others do not.

The disability insurer must give you reasonable notice of the time, place, and name of the IMEexaminer as well as the scope of the evaluation. You have the right to be reimbursed for mileageto and from the place of the evaluation, and the insurer must reimburse the examining physicianfor the evaluation report. The IME physician is required to provide a copy of the report to you,or, your attorney within a reasonable time after the examination.

In exchange, you are required to provide copies of all medical office treatment notes, labreports, consultations etc. from each physician who has examined or treated you for theimpairment you are now claiming. In addition, most disability companies will also ask you for asigned authorization so that other information may be obtained before your IME date. I realizethis may seem as though your privacy is being invaded, but patient/doctor privilege with respectto the condition causing you to stop working is generally considered to be waived at the time youmake application for disability compensation.

The IME physician may be subpoenaed to give testimony under oath during a deposition, andmay be cross-examined at trial if your claim is litigated at a later date. Therefore, it is extremelyimportant to be prepared for the IME and understand the objectives of the examiner.

A disability “Independent Medical Evaluation” is a physical examination by a medical doctorchosen by your disability insurer for the purpose of providing credible written medicaldocumentation which can be used by the disability insurer at any time to support a termination ofbenefits.

In theory, IME’s are intended to “clarify” very complex medical restrictions and limitations.However, in actual practice, the independent medical evaluation is a “risk management” toolpaid for by the disability insurer which “rubber stamps” a future decision to deny your claim.

Denial decisions made by the disability insurer do not happen over night. Your claim for benefitsis “risk managed,” a term I refer to as “stacking the deck.” The disability insurer refers yourclaim through a very complex internal review system whereby each medical and/or vocationalresource provides a written document explaining all of the reasons why that resource believesyou can work and are not disabled. Each in-house resource lends their certification credential—nurses are RN’s, vocational specialists are CRC’s (Certified Rehabilitation Counselors), and ofcourse physicians are always “Board Certified” in their specialty.

Most disability insurance providers maintain a master list of “IME Physician Network”participants. These IME physicians perform hundreds of medical evaluations each year for theinsurance industry, and make doing so a large part of their practice. Their bias in favor of theinsurance company is well known. The regular fee charged for performing these IME’s rangefrom $1,200 to $5,000 for detailed two day neuropsychiatric exams. If a physician is asked togive testimony at trial, the bill charged to the insurance company, doubles, or even triples. The“business” of performing several hundreds of insurance IME’s proves to be very lucrative for thephysician.

You do the math. For some specialties, performing IME examinations can be more profitable than clinical services!

The problem is, these insurance industry physicians are not “independent medical examiners” byany sense of definition, and can actually add to the controversy of medical impairment bydrawing conclusions, writing reports, and providing testimony that is clearly biased in favor ofthe insurance company. In addition, after long periods of time, the IME physician becomesextremely knowledgeable of the disability lingo, and assumes the role of the disability claimsspecialist, or vocational consultant, and documents statements in his/her report about youroccupation and how you do not meet the definition of disability in your policy.

The IME physician often becomes the “devil’s advocate” who renders opinions and conclusionsoutside of his or her medical expertise. IME physicians may also assume the role of a disabilityclaims investigator, paid by the insurance company, to provide documentation adverse to youand your claim.

Therefore, it is important to remember IME physicians are not concerned with your medical wellbeing, and themselves have a clearly defined agenda and strategy to assist the insurancecompany with what appears to be, credible, objective medical opinion contrary to that of yourprimary care physician.

Their role is to attack the credibility of the insured by assuming every claim for benefits is afraud that must be exposed. Therefore, the claimant is dishonest. It is a great deal easier to attackyour credibility, and the judgment of your physician than it is to ascertain medical restrictionsand limitations preventing you from returning to work. In doing so, the conclusion could befavorable to YOU and that would be adverse to the insurance company.

IME physicians are provided with all the medical information you previously sent to your claimsexaminer, plus the copies of the in-house medical write-ups done by the insurance companyphysicians. Therefore, the IME physician already knows the “opinion” of the insurancecompany concerning your ability to work before you arrive for the evaluation. It seemsreasonable to conclude the IME physician may have already formed an opinion concerning yourimpairment, especially when the insurance company also provides non-medical information suchas the amount of your monthly benefit. The higher it is, the more persuaded the IME physicianmay be to document his/her medical conclusion in accordance with the insurance company’sagenda of terminating your claim.

Documentation, written by well-credentialed specialists is added to your claim piece by piece,and is done to give the appearance of fairness and objectivity when in fact the claim is beingprepared step-by-step for denial.Disability claims are very rarely denied in short, closed periodsof time. It takes willful effort and a lot of work to legally document the reasons why everyone employed by the insurance company believes you are not impaired and entitled to benefits.

It takes a long time to “stack the deck” ( your file ) in favor of denying you the benefits to which you are entitled.

As previously mentioned, IME examinations are one of many “risk” activities used by thedisability insurer to attack the credibility of you and your primary care providers. The internaldecision to request an IME is not made by just one individual, but a series of people—nurses,doctors, managers, consultants and claims examiners. Everyone working on your claim knowsthe intended reason for the IME is to document a future denial, but the exam is positioned verydifferently with you since the company needs your cooperation. You are more likely to give it ifyou are under the impression the insurance company is requesting the evaluation to “award”benefits and not “deny” them.

This booklet is intended to offer suggestions for managing a request from your disability insurerfor an Independent Medical Evaluation. Although the insurance company may convince you it isin control of the process, the suggestions that follow will assist you in making sure the IME is asfair and objective as it can be, given the fact that your disability insurer is looking to createsupportive documentation to deny your claim. It is probable if you are not prepared for theevaluation, your claim may be denied or seriously damaged. Although the following suggestionswon’t guarantee a continuation of your benefits, knowing the process is certainly an importantstep protecting your rights.

The IME Process—Preparing Yourself1.Most likely you will receive a call from your claims examiner asking you to submit to anIndependent Medical Evaluation. During this same call, the claims handler will conductwhat is referred to as “an in-depth phone interview.” The purpose of the phoneinterrogation is to obtain facts and comments from you which may be used after theevaluation to show you are inconsistent with your responses.What you say to the claims handler and what you tell the IME doctor should be the same. For example, if you tell the claims handler you can’t use your hands or carry heavy objects, don’t lift a large bag and drive an RV the day of the IME.Always use common sense. Remember, the disability insurer may have arranged a “tag” surveillance the day before, the day of, and the day after your IME. Whatever you tell the claims examiner about your physical capacity should be the same as what you tell the IME physician, and should also be the same as any observed activity should the company surveil you just before the exam.Keep in mind when speaking with the insurance company to answer only the questions asked, then bequiet. Never volunteer or offer additional information other than what is asked.2Once you know the date and time of the evaluation, call your primary care physician andmake an appointment with him/her just after the IME. Inform your primary carephysician at that time that your disability insurer has asked you to submit to an IME. Thissecond examination serves two purposes: 1) it provides documentation of your physicalcondition by your physician on the same day as the IME exam, and 2) sometimes theIME physician may be a little rough and cause you to swell or have pain. These physicalsymptoms will be documented by your physician as well. Tell your physician if you havepain, swelling, or any other physical symptoms as a result of the IME. Thedocumentation of your own doctor may be extremely important when pointing outinconsistent and unreasonable conclusions made by the IME physician.

3.You should meet with your attorney, if you have one, in advance to go over all of yourprior medical records and history of your present illness. One way in which the IMEphysician may draw suspicion to your claim is to “catch” you in inconsistencies whenyou talk about your prior medical history. A simple lapse of memory by not mentioning aparticular doctor, or lab test you had in the past is sufficient for the IME doctor toconclude you are trying to hide something and your claim is fraudulent. No priorphysician visit or treatment should be left out of your history, as you will certainly beasked about it at the beginning of the exam. You should be prepared either by yourattorney, or by studying your own medical records, well in advance of your IME date.Refresh yourself with the following information: chronological medical history; astatement of the nature and extent of disability; the date you first stopped working andwhy; how your disability has affected your activities of daily living (toileting,transferring, meal preparation, dressing and undressing, preparation of meals etc.);restrictions and limitations given by all treating physicians,; and a complete descriptionof your treatment plan discussed previously with your physician.Only when you arethoroughly prepared for discussing your medical history, can you avoid the “traps” ofgiving an inaccurate or inconsistent medical history.Skilled IME physicians will literally“pounce” on every omitted detail no matter how insignificant it may seem.

4.Send a certified, return receipt requested notice to the disability insurer requesting awritten reply to the following questions:

1) What percentage of the IME physician’s practice is devoted to diagnosing andtreating patients who are totally disabled from the same condition you nowhave?

2) How long has the IME physician been employed by the insurancecompany as an IME physician and what percentage of his decision reports havebeen favorable to the claimant?

3) Request a copy of the Curriculum Vitae ofthe IME physician.

4) Request copies of any published articles the IME physicianhas written on the topic of your particular diagnosis.

5) Ask for a written statement explaining the basis for selecting this particular IME physician overothers to conduct the exam. This question is especially important if you are being asked to travel a long distance to attend the exam when other well qualified physicians are within your own geographical area. Look up the IME physician on the Internet and verify his credentials.

6) Request copies of the IME report be forwarded to both you and your primary carephysician. Remember to send this letter, certified, return receipt requested. In the caseof mental or nervous conditions state in the letter it is permitted to send the reportdirectly to you. Some insurance companies send such reports to your psychiatrist orcounselor rather than to you.

5. Request a continuance of the date (if appropriate) to allow you and your primary carephysician sufficient time to examine the credentials of the designated IME physician.

6. Never attend an independent medical evaluation alone. On the day of the exam, do notengage in any substantial activity. Remain ever cognizant of the fact the insurancecompany may have requested surveillance. Leave your house accompanied by someonewho can assist you during the exam, ask questions for you, and/or take notes ofprocedures during the exam. If you are required to wear braces, wear them to the exam. Ifyou use a cane, bring it with you, and use it. Bring a camera with you and take a pictureof any swollen body part at the IME doctor’s office. For example, one person attendedan IME with a swollen hand, so she lifted up the hand next to the IME doctor’s certificateon the wall, and took a picture. Later, the IME doctor wrote in his report that “there wasno swelling”, but the claimant’s picture said it all. Ask your companion to take accuratenotes and to observe how the IME physician treats you during the examination. Takesomeone with you who is fairly assertive and who would not have a problem asking for abreak if you become tired, or need something to drink. Your companion is there to beprotective of your personal needs during the exam, and document what took place.

7. IME physicians use certain exams to trick you. One such test is referred to as Waddell’ssigns, used by IME physicians to identify psychological factors in patients claiming backproblems from trauma, chronic pain and fibromyalgia. So-called “false positives” onthese indicators are often at the root of adverse decisions documented by the IMEphysician. The IME physician will perform a hands-on examination for each test, lookingfor you to say “it hurts” when in fact it is impossible, given nerve or sensory distributionfor it to really cause pain. In other words, the IME physician “tricks you” into saying ithurts when it really shouldn’t, given the injury or diagnosis you have. I’m going to tryand explain these Waddell signs in layman’s language so that you will understand them.Tenderness-- the doctor will lightly touch or pinch your skin over a wide area beyond thenormal distribution of the sensory nerves. If you say these light touches are sensitive and tender,superficially, the IME physician will suspect exaggeration. If you say you have pain whendeeply touched over a wide area beyond the area of an injury or joint, the doctor will suspectexaggeration. Usually pain is only evident in the localized area of the injury. If you havefibromyalgia and say you have pain “everywhere”, the doctor will suspect your reactions.Simulation Tests-- If the doctor presses down on your head while you are standing (axialloading), and you report low back pain, the doctor will say you are exaggerating. If the doctorrotates your shoulders and pelvis at the same time while standing, and you are complaining oflow back pain, the doctor will say you are exaggerating.

Distraction Tests-- On occasion when the IME physician finds something wrong, he/she maydistract you, performing another test of the same area without telling you why. If you have anegative reaction, or don’t give a full effort, the doctor will suspect exaggeration. An example ofthis is to ask the patient to raise one leg against resistance while lying down. If your opposite legdoes not press down, for leverage, then the doctors suspects you are not giving full effort for thepurpose of exaggeration. Sometimes, the IME physicians will just walk away from yousupposedly to write something down in your chart, then quickly ask you a question. If you “turnyour head” in his direction when you told him you couldn’t do that because of pain, the doctorwill suspect all of your complaints. In most instances, the doctor has already examined you formovement in that area, causing you to believe the exam was completed.

Regional Disturbances-- If you complain of excessive weakness, such as the giving way ofmuscles within a particular group, the doctor will say you are exaggerating. Likewise, if youclaim numbness, tingling or pain over an area outside of the distribution where the nerves fromthe spine lead down the leg into the toes, the doctor may suspect exaggeration. This is especiallytrue for fibromyalgia and chronic fatigue claim.

Overreaction-- If you cringe, grimace or otherwise show unnatural responses to sensory, motoror reflex tests (all of the above), the doctor may suspect exaggeration.

8. Remember the IME physician is not examining you to give you medical advice. He/shewill not discuss treatment options with you, nor will he recommend appropriate treatmentfor your impairment. An IME physician will generally not give you an opportunity toexplain what is really disabling you, and will ask only questions requiring a “yes” or “no”answer. It is very human and natural, once you are committed to an IME exam, to want tobe believed, and acknowledge the doctor examining you is acting in your best interests.

However, once you thoroughly understand the IME physician’s role is to represent theinsurance company and not you, then you can present yourself appropriately during theexam.Technically, you are patient with a medical problem and you may feel the need toask the IME physician medical questions about your impairment. It is unlikely the IMEphysician will tell you anything substantial as an answer.6